Hospital readmissions: Can the Affordable Care Act help?

East Tennessee State University
Health Care Policy
R50-M13C
Dr. Francisca Farrar
June 21, 2013

Hospital readmissions: Can the Affordable Care Act help? Flaws within the healthcare system have hospital readmission rates at “about 2.6 million seniors” (Sebelius, 2013, para. 6), returning within the first 30 days of discharge. The Affordable Care Act (ACA) plans to restructure the quality of care received before and after discharge and form better and faster ways of communication to the primary care physician. How can this be accomplished? The ACA plans to work on having “physician-led provider teams that provide continuous and coordinated care, emphasize prevention and effective management of chronic illness, and strive for improved access and communication” (Andrews, Darnell, McBride, & Gehlert, 2013, p. 69).
A coordinated care team in place at the hospital would consist of the internalist, nurse, nutritionist, physical, speech and occupational therapist, case management and the patient. Case management begins “the day the patient is admitted” (I. Pickering, personal communication, June 17, 2013) working on the discharge. Case management is the key provider for the community provided programs, Home Health to assist in further educational assistance regarding newly diagnosed issues, preventive issues, Hospice at end of life care and any equipment ordered needing to be delivered prior to patient discharge. Early delivery assists with an easier transition home allowing for set up and family/caregiver instruction on proper usage. “In a related sense, social work is guided by an evidence base that is informed by rigorous research within communities and collective wisdom gleaned from over a century of social work practice” (Andrews et al., 2013, p. 67). The RN should consider contacting the primary care physician of the patient; “one of the biggest barriers to smoother care transitions is the fact that primary care physicians often have little or no information about their patients’ hospitalizations” (Burton, 2012, para. 9). Nursing will be administering proper care according to the care plan implemented and giving thought to discharge educational material proper for the patient’s diagnosis and history. The RN will collaborate daily with the physician regarding new issues discovered, medication questions and receives updates on how the discharge plan is coming from Case management. The internalist will maintain correspondence with the patient on a daily basis, addressing all concerns and at discharge make sure that there is a “timely transfer of accurate, relevant data about diagnostic findings, treatment, complications, consultations, tests pending at discharge, and arrangements for post discharge follow-up” (Kripalani et al., 2007, p. 831). A patient’s discharge information sent to the primary care physician will maintain the continuity of needed care and increase chances the patient will not be a statistic on the readmission list. One of the major concerns to be addressed regarding the patient at discharge is the list of home medications. The physician, in collaboration with the nurse, should perform a thorough verification of the discharge medications for any possible contraindications that may arise before the scheduled follow up appointment.
How will the patient benefit from the actions of the ACA? “The new law establishes new Accountable Care Organizations (ACO) that incentivize doctors and providers to work together to provide more coordinated care to their patients” (Sebelius, 2013, para. 2). Once the collaboration of the care team begins working together on a plan for the patient’s continued care inside and outside of the hospital setting; any issues that may not have been noticed before can be dealt with. In section 2717, Item A, subsection 1a. of the ACA the implementation of activities dealing in medication and care